Management of a woman at elevated risk for breast cancer

Abstract

Early breast cancer detection decreases mortality. As a result, it is imperative that primary care physicians are able to identify those individuals who are at an increased risk for breast cancer and understand how to help the patients manage that risk. Hereditary cancer syndromes in particular are dangerous and under-recognized. Various risk assessment tools are available for patients who are not at hereditary risk to help determine who may be eligible for enhanced screening or those who may benefit from preventive medication, and many imaging centers have now incorporated a form of risk assessment with associated recommendations into their reporting structure. Some patients even wish to consider risk-reducing surgery, which requires special counseling and support. All women should be risk stratified as early as possible so that those at a high risk can benefit from risk-stratified care. The management of patients at increased risk for the development of breast cancer has become increasingly challenging and nuanced with the exploding field of germline genetic testing and its implications for personalized care, and an increasing number of available options for high-quality supplemental breast imaging, particularly for the patient with dense breast tissue. This chapter aims to outline the identification and management of the high-risk patient, focusing on salient genetic and nongenetic risk factors, available options for risk management, and recommendations for risk modification for all women.